et tu...? Acupuncture and pain in Nature

Physician and blogger Harriet Hall, MD, once coined an exceptionally apt phrase to describe research in many alternative medicine modalities - "Tooth Fairy Science"; it refers to research undertakings into a phenomenon whose existence is yet to be established. In a post in her blog Science-based Medicine, she explained:

You could measure how much money the Tooth Fairy leaves under the pillow, whether she leaves more cash for the first or last tooth, whether the payoff is greater if you leave the tooth in a plastic baggie versus wrapped in Kleenex. You can get all kinds of good data that is reproducible and statistically significant. Yes, you have learned something. But you haven't learned what you think you've learned, because you haven't bothered to establish whether the Tooth Fairy really exists.

Priceless. And of all the modalities championed by modern peddlers of pseudoscience, acupuncture most certainly qualifies as a prime example of Tooth Fairy Science.

Does acupuncture work in depression control? Nope.

This past weekend, the New York Times published an article on a study from Stanford University, where the authors apparently found benefit from acupuncture in pregnant women with Major depression. Given the track record of acupuncture (which features a resounding lack of evidence that it works), my skeptical antennae started twitching. I ferreted out the original study in the Obstetrics and Gynecology journal (link to full text here), and read it through thoroughly. This report - of a single randomized clinical trial (RCT) study with less than 150 subjects - claimed that an acupuncture regimen, specifically designed for a particular individual, could significantly reduce depression in that individual. As I suspected, the paper made a whole lot of science-y sounding, but nonetheless vacuous, arguments; their predominant talking point seemed to be that multiple exploratory analyses were done on the observed outcome. This assertion is always suspect; for an RCT, it shouldn't need so many exploratory analyses at the study stage, and the outcome measures should have been determined prior to the initiation of the study. As a friend of mine pointed out, "exploratory analyses" frequency means "fishing expedition", which is what this paper seems to have done in plenty. Unfortunately, the mainstream media coverage of this single study has been far from ideal; the news report has been worded to make it seem like a breakthrough or a major milestone in research, which is the impression the general public is left with - eventually to their detriment.